VBS 2017 - Child Registration Form

Please complete ONE FORM FOR EACH CHILD registering. Open to children age 4 (by 7/24) to current 5th graders.

Maker Fun Factory: Created by God, Built for a Purpose, July 24 - 28 (9:00 a.m. to 12 noon).

Child's Name*

First Name

Last Name

Child's age as of July 24, 2017*

Street Address*

City, State and Zip*

Home Phone*

Email Contact (required)*

Child's Date of Birth*

MM

/

DD

/

YYYY

Child's Gender*

Male

Female

Grade completed as of June, 2017*

Pre-K

Kindergarten

First

Second

Third

Fourth

Fifth

MEDICAL & OTHER IMPORTANT INFORMATION

Allergies or other medical conditions of which we need to be aware:

Will your child be bringing any medications?

Yes

No

If yes, please describe.

Are there any special needs of which we need to be aware?

Church you attend:

Does your child have permission to ride a bike or walk home?

Yes

No

The following people have permission to pick up my child from VBS:

EMERGENCY CONTACT INFORMATION (at least one must be provided)

Mother's Name

First Name

Last Name

Mother's Cell Phone

Father's Name

First Name

Last Name

Father's Cell Phone

Other Emergency Contact

First Name

Last Name

Other Emergency Contact's Cell Phone

SINCE OUR GROUPS ARE MULTI-AGED, YOUR CHILD WILL BE PLACED IN A GROUP WITH CHILDREN RANGING FROM KINDERGARTEN TO 5TH GRADE. WE ENCOURAGE OUR CHILDREN TO MAKE NEW FRIENDS WHILE ATTENDING VACATION BIBLE SCHOOL.

The cost for VBS will be $15.00 per child which includes a T-Shirt, crafts/materials, and a family music CD. REGISTRATION WILL NOT BE CONSIDERED COMPLETE UNTIL PAYMENT IS RECEIVED. Please make checks payable to LUMC and designate VBS in the memo line. (Checks may be turned in to the church office or directly to Debbie Andrews or Beth McOsker.) Scholarships are available. NO REFUNDS WILL BE GIVEN.

A T-SHIRT WILL BE PROVIDED TO EACH CHILD.

Child's t-shirt size:*

PARENT SIGNATURE

I understand my child may be photographed during VBS in group or crew photos and by entering my name below I give my permission for my child to participate in Lynnhaven UMC's VBS 2017 and appear in photographs taken during the program.*